Citation Nr: 9915488
Decision Date: 06/03/99 Archive Date: 06/15/99
DOCKET NO. 97-17 384 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Winston-Salem, North Carolina
THE ISSUE
Entitlement to service connection for the cause of the
veteran's death.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
C. Schlosser, Associate Counsel
INTRODUCTION
The veteran had active military service from October 1976 to
August 1981.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a July 1996 rating action in which the
RO denied, among other things, service connection for the
cause of the veteran's death. By a July 23, 1996, letter,
the RO also informed the appellant that a claim for accrued
benefits, death pension, and dependency and indemnity
compensation under 38 U.S.C.A. § 1318(b) (West 1991) had been
denied. The denial of service connection for the cause of
the veteran's death was the only issue thereafter appealed.
38 C.F.R. §§ 20.200, 20.302(c) (1998) (an appeal is initiated
by a notice of disagreement and is completed only by filing a
substantive appeal after issuance of a statement of the case
or supplemental statement of the case which addresses the
issues that the appellant desires to appeal).
FINDINGS OF FACT
1. The veteran was exposed to benzene or benzene-like
compounds in service while performing her duties as an
aircraft maintenance specialist.
2. The veteran was diagnosed with acute myeloid leukemia in
1991.
3. It is likely that prolonged exposure to benzene or
benzene-like compounds in service led to the development of
acute myeloid leukemia.
4. Complications from acute myeloid leukemia contributed
significantly to the veteran's death.
CONCLUSION OF LAW
Service connection is warranted for the cause of the
veteran's death. 38 U.S.C.A. §§ 1101, 1110, 1112, 1310 (West
1991 & Supp. 1998); 38 C.F.R. §§ 3.102, 3.312 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Factual Background
The death certificate reveals that the veteran died on May
[redacted] 1996. The immediate cause of death was listed as
respiratory arrest. The primary causes of death, in
sequential order, were listed as multi-organ system failure,
graft versus host disease, and umbilical cord blood
transplant for leukemia. An autopsy was performed. At the
time of the veteran's death, she was hospitalized at the Duke
Medical Center in Durham, North Carolina. The hospital
summary and clinical records of the terminal period of
hospitalization reflect a primary diagnosis of acute myeloid
leukemia with multiple secondary diagnoses.
The veteran's service medical records are negative for any
diagnosis of acute myeloid leukemia. The veteran's
occupational specialty in service was aircraft maintenance
specialist.
Post-service treatment records show that the veteran was seen
at Seymour Johnson Air Force Base in June 1991 after
experiencing pounding in her chest along with some mild chest
pain for the previous few weeks. Subsequent evaluation at
the Southeastern Medical Oncology Center resulted in a
diagnosis of pancytopenia, probably secondary to pre-leukemia
or frank leukemia. The veteran underwent chemotherapy and
the leukemia was noted to be in remission in October 1991.
In August 1992, the veteran filed a claim for entitlement to
service connection for acute myelogenous leukemia. She
contended that she served as an F-4 crew chief in service and
was exposed to numerous carcinogens including F-4E and F-4F
radar transmissions, various fuels, greases, oils, cleaning
compounds, ECM transmissions, aircraft cleaning soap, and
asbestos gloves.
On VA examination in September 1992, diagnoses included acute
myelogenous leukemia, history of total body radiation,
chemotherapy, bone marrow transplant, multiple bone marrow
biopsies and aspirations, and history of exposure to radar,
jet fuel, oil and asbestos gloves.
In a May 1993 letter to the veteran, the RO requested
information from the veteran about her alleged exposure to
carcinogens in service. In a June 1993 letter, the veteran
outlined her in-service duties which exposed her to the
carcinogens previously identified in her claim for service
connection. She stated that her occupational history in
service included work on both flightline and phase inspection
maintenance from 1976 to 1981. Her duties included, but were
not limited to the following: washing aircraft with PD-680
which contained petroleum distillates, NAPTHA; treating minor
corrosion using lacquer paints which contained toluene,
methylene chloride, acetone, NAPTHA; launching, recovering
and operating aircraft while radar was in operation; removing
and replacing panels, doors, radomes; removing, replacing,
lubricating and servicing landing gear and components, wheel
and tire assemblies, and brake assemblies, using MIL-C-83360
containing antimonytrioxide and inorganic lead compounds;
servicing and draining liquid oxygen, and removing and
installing liquid oxygen converters with asbestos gloves for
protection; lubricating aircraft flight controls, parts and
assemblies, and aircraft engines with various oils and
lubricants including, but not limited to VV-L-800, molybdenum
grease and leak tek; servicing and draining hydraulic
systems, pneudraulic systems, nitrogen systems, and pneumatic
systems; removing and installing system components; servicing
aircraft with JP-4 fuel which contained petroleum distillates
(NAPTHA), benzene and toluene; removing and installing
external JP-4 fuel tanks and fuel filters; inspecting and
repairing JP-4 fuel leaks; inspecting, removing, and
replacing engines and engine components; and removing and
installing nickel-cadmium aircraft batteries. The veteran
further stated that her post-service occupational history
consisted of office work and educational pursuits without any
known exposure to carcinogens.
Thereafter, the RO undertook significant efforts to ascertain
whether the veteran had been exposed to radiation in service.
The RO requested information about possible radiation
exposure the veteran may have experienced in service from the
United States Air Force Occupational Health Laboratory, the
Defense Nuclear Agency, the Navy Dosimetry Center, the USA
Ionizing Radiation Dosimetry Center, and the Reynolds
Electrical &Engineering Co., Inc. These requests were met
with negative results.
In February 1995, the veteran submitted a January 1995 letter
from her treating oncologist, Lance Loomer, M.D., at the
Southeastern Medical Oncology Center. Dr. Loomer indicated
that, if the veteran was indeed exposed to benzene or
benzene-like compounds, it was definitely possible that her
leukemia arose from such exposure. Dr. Loomer went on to
state that the lag time in developing leukemia after exposure
peaked at approximately eight years and then plateaued at a
3-4% probability. He indicated that it was consequently rare
to develop leukemia immediately, and that it would be much
more common to develop leukemia years later as in the case of
the veteran.
The veteran also submitted abstracts from several articles
which reportedly linked exposure to certain carcinogens,
including benzene compounds, to the development of leukemia.
Following the death of the veteran in May 1996, the appellant
submitted a document from the veteran's service medical
records which showed treatment in service for a chemical burn
of the right upper extremity while using PD-680 during a
cleaning operation in 1977.
II. Analysis
Initially, the Board finds that the appellant's claim for
service connection for the cause of the veteran's death is
well grounded within the meaning of 38 U.S.C.A. § 5107(a).
That is, he has presented a claim which is not inherently
implausible, especially given the veteran's previously
submitted statements regarding in-service chemical exposure,
the opinion by Dr. Loomer, and the abstracts of certain
medical articles. See Murphy v. Derwinski, 1 Vet.App. 78, 81
(1990).
In order to establish service connection for a disability,
there must be objective evidence that establishes that such
disability either began in or was aggravated by service.
38 U.S.C.A. § 1110. A determination of service connection
requires a finding of the existence of a current disability
and a determination of a relationship between that disability
and an injury or disease incurred in service. Watson v.
Brown, 4 Vet.App. 309, 314 (1993). The death of a veteran
will be considered as having been due to a service-connected
disability when the evidence establishes that such disability
was either the principal or a contributory cause of death.
The service-connected disability will be considered as the
principal (primary) cause of death when such disability,
singly or jointly with some other condition, was the
immediate or underlying cause of death or was etiologically
related thereto. 38 C.F.R. § 3.312 (1998). For a service-
connected disability to be considered the principal or
primary cause of death, it must singly, or with some other
condition, be the immediate or underlying cause, or be
etiologically related thereto. 38 C.F.R. § 3.312(b) (1998).
In determining whether a service-connected disability
contributed to death, it must be shown that it contributed
substantially or materially; that it combined to cause death;
that it aided or lent assistance to the production of death.
38 C.F.R. § 3.312(c) (1998).
The veteran's occupational specialty in service was aircraft
maintenance specialist. Prior to her death, the veteran
alleged that she had been exposed to multiple carcinogens,
including benzene compounds, during her duties as an aircraft
maintenance specialist. Based on her occupational specialty
in service, and the expertise regarding fuels, solvents, and
the like implicit in such a specialty, the Board finds that
the veteran's reference to exposure to certain chemicals,
including benzene, to be both credible and competent evidence
of such exposure. There is evidence of record which confirms
that the veteran was diagnosed with acute myeloid leukemia in
1991, ten years after her discharge from service. As noted
above, there is also a private medical opinion from the
veteran's treating oncologist, as well as evidence contained
in two referenced treatises which strongly suggests a
relationship between exposure to benzene compounds and
subsequent development of acute myeloid leukemia. This
increased risk is supported by information contained in two
medical treatises. Cecil Textbook of Medicine, (James B.
Wyngaarden, M.D., Lloyd H. Smith, Jr., M.D., and J. Claude
Bennett, M.D., eds., 19th ed. 1992), provides, in part, that
heavy occupational exposure to benzene frequently results in
marrow hypoplasia, which sometimes evolves into acute
leukemia. Similarly, Harrison's Principles of Internal
Medicine, (Anthony S. Fauci, M.D., Joseph B. Martin, M.D.,
Eugene Braunwald, M.D., Dennis L. Kasper, M.D., Kurt J.
Isselbacher, M.D., Stephen L. Hause, M.D., Jean D. Wilson,
M.D., and Dan L. Longo, M.D., eds., 14th ed. 1998), notes
that benzene used as a solvent has been related to an
increased incidence of acute myeloid leukemia.
The Board finds that the evidence, both positive and
negative, is at least in relevant equipoise. When after
careful consideration of all procurable and assembled data, a
reasonable doubt arises regarding service origin, the degree
of disability or any other point, such doubt will be resolved
in favor of the claimant. 38 U.S.C.A. § 5107; 38 C.F.R.
§ 3.102. Under such circumstances, the Board concludes that
the evidence supports a grant of service connection for the
cause of the veteran's death. 38 C.F.R. §§ 3.102, 3.303
(1998).
It is clear from review of the veteran's death certificate
that complications from the veteran's acute myeloid leukemia
were a significant contributing cause of her death. Pursuant
to the provisions of 38 U.S.C.A. § 5107(b) (West 1991) and 38
C.F.R. § 3.312(c) (1998), service connection for the cause of
the veteran's death is granted.
ORDER
Service connection for the cause of the veteran's death is
granted.
MARK F. HALSEY
Member, Board of Veterans' Appeals